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Official Description

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)
Short Descr Home vent non-invasive inter
Coverage Special coverage instructions apply
Pricing Indicator(s) 31 – Supplies And Surgical Dressings - Frequently serviced DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 60-9
Processing Note PUBLICATION 100-03, CHAPTER 1, SECTION 280.1 (100.03, 1, 280.1).
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/2016
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
IOM 100-03, 4, 280.1
OTS Orthotic No
RR Rental (use the 'rr' modifier when dme is to be rented)
CR Catastrophe/disaster related
KX Requirements specified in the medical policy have been met
GW Service not related to the hospice patient's terminal condition
GA Waiver of liability statement issued as required by payer policy, individual case
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ Item or service expected to be denied as not reasonable and necessary
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
KR Rental item, billing for partial month
N1 Group 1 oxygen coverage criteria met
TW Back-up equipment
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KZ New coverage not implemented by managed care
N2 Group 2 oxygen coverage criteria met
RA Replacement of a dme, orthotic or prosthetic item
U3 Medicaid level of care 3, as defined by each state
Date
Action
Notes
2016-01-01 Added Added
Code
Description
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